Prognostic Value of Incremental Pacing Maneuver for Long-Term Recurrences After Typical Flutter Ablation

Vallès, Ermengol; Bazán, Víctor; Caínzos, Miguel; Benito, Begoña; Jauregui, Miguel E.; Bruguera, Jordi; Marti, J.

doi:10.1016/s0735-1097(13)60321-6

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“…12 This distinction is crucial because demonstration of CTI block is necessary to prevent AFL recurrences. 12,13 Our data show that little (<10 ms) variation in the His-to-CSO atrial EGM interval in response to progressively faster (from 600 ms to 300 ms) pacing from the LLRA is indicative of complete CTI block, whereas a >10 ms increase of the His-to-CSO atrial interval with IP would support slow conduction and functional block across the CTI. The correlation of this technique to the previously validated IP maneuver seems excellent.…”

Section: Discussionmentioning

confidence: 63%

“…It has been shown that confirmation of complete CTI block by means of the IP maneuver is accompanied by a reduced incidence of typical flutter long-term recurrences. 12,13 It remains unproven whether application of the incremental His-to-CSO maneuver might also result in a reduction of AFL recurrences during follow-up. …”

Section: Limitationsmentioning

confidence: 99%

“…12 In fact, confirmation of complete CTI block by IP has been associated with a lower incidence of AFL recurrences after ablation. 12,13 However, a limitation of such maneuver is that it requires the identification of 2 distinct potentials in the CTI ablation line during ablation, which is not always feasible, because multiple and fragmented potentials are commonly observed in relation to a broad or nonlinear ablation. We therefore developed a novel simple maneuver analogous to the IP maneuver based on examination of the atrial EGMs at the His and CSO regions, thus avoiding the need for evaluation of local EGMs throughout the CTI ablation line.…”

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confidence: 99%

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Incremental His-To-Coronary Sinus Maneuver

Vallès

Bazán

Benito

et al. 2013

Circ: Arrhythmia and Electrophysiology

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Background-Achievement of complete cavotricuspid isthmus (CTI) conduction block reduces typical atrial flutter recurrences after ablation. The lack of increase in the His-to-Coronary sinus ostium atrial interval during incremental pacing (IP) from the low lateral right atrium may distinguish slow conduction from complete CTI conduction block. Methods and Results-Sixty-six consecutive patients (age, 65±13 years; 18% female) were prospectively included. A <10 ms increase in the His-to-Coronary sinus ostium atrial timing during low lateral right atrium IP at cycle length of 600 ms through 300 ms was compared with the previously reported IP maneuver for the confirmation of complete CTI block. On the basis of the IP maneuver, complete CTI block (phase 2) was achieved in 59 patients, in 13 of whom an intermediate phase of functional CTI block (phase 1) was observed. In the remaining 7 patients, the IP maneuver did not allow for assessment of complete CTI block because of the presence of inconclusive potentials in the CTI ablation line. As compared with the IP maneuver, the incremental His-to-Coronary sinus ostium maneuver was consistent with functional CTI block during phase 1 in all cases and conclusive of complete CTI block in 98% of cases during phase 2. Conclusions-The incremental His-to-Coronary sinus ostium maneuver is analogous to the IP maneuver in distinguishing complete CTI block from persistent CTI conduction. This maneuver may provide confirmation of CTI block in those patients in whom assessment of local electrogram-based criteria is not feasible because of inconclusive potentials in the CTI ablation line. (Circ Arrhythm Electrophysiol. 2013;6:784-789.)Key Words: ablation ◼ cavotricuspid isthmus ◼ complete block ◼ incremental His-to-coronary sinus maneuver ◼ incremental pacing ◼ typical flutter

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Section: Discussionmentioning

confidence: 63%

Section: Limitationsmentioning

confidence: 99%

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